Basic Life Support (BLS)

Adult BLS sequence

Basic life support consists of the following sequence of actions:

1 Make sure the victim, any bystanders, and you are safe.

2 Check the victim for a response.

• Gently shake his shoulders and ask loudly, ‘Are you all right?’

3 A If he responds:

• Leave him in the position in which you find him provided there is no

further danger.

• Try to find out what is wrong with him and get help if needed.

• Reassess him regularly.

Resuscitation Council (UK)

3 B If he does not respond:

• Shout for help.

• Turn the victim onto his back and then open the airway using head tilt

and chin lift:

o Place your hand on his forehead and gently tilt his head back.

o With your fingertips under the point of the victim's chin, lift the

chin to open the airway.

4 Keeping the airway open, look, listen, and feel for normal breathing.

• Look for chest movement.

• Listen at the victim's mouth for breath sounds.

• Feel for air on your cheek.

In the first few minutes after cardiac arrest, a victim may be barely

breathing, or taking infrequent, noisy, gasps. Do not confuse this with

normal breathing.

Look, listen, and feel for no more than 10 sec to determine if the victim is

breathing normally. If you have any doubt whether breathing is normal,

act as if it is not normal.

5 A If he is breathing normally:

• Turn him into the recovery position (see below).

• Send or go for help, or call for an ambulance.

• Check for continued breathing.

5 B If he is not breathing normally:

• Ask someone to call for an ambulance or, if you are on your own, do

this yourself; you may need to leave the victim. Start chest

compression as follows:

o Kneel by the side of the victim.

o Place the heel of one hand in the centre of the victim’s chest.

o Place the heel of your other hand on top of the first hand.

o Interlock the fingers of your hands and ensure that pressure is

not applied over the victim's ribs. Do not apply any pressure

over the upper abdomen or the bottom end of the bony

sternum (breastbone).

o Position yourself vertically above the victim's chest and, with

your arms straight, press down on the sternum 4 - 5 cm.

o After each compression, release all the pressure on the chest

without losing contact between your hands and the sternum.

Repeat at a rate of about 100 times a minute (a little less than

2 compressions a second).

o Compression and release should take an equal amount of

time.

6 A Combine chest compression with rescue breaths.

• After 30 compressions open the airway again using head tilt and chin

lift.

• Pinch the soft part of the victim’s nose closed, using the index finger

and thumb of your hand on his forehead.

• Allow his mouth to open, but maintain chin lift.

• Take a normal breath and place your lips around his mouth, making

sure that you have a good seal.

• Blow steadily into his mouth whilst watching for his chest to rise; take

about one second to make his chest rise as in normal breathing; this

is an effective rescue breath.

• Maintaining head tilt and chin lift, take your mouth away from the

victim and watch for his chest to fall as air comes out.

• Take another normal breath and blow into the victim’s mouth once

more to give a total of two effective rescue breaths. Then return your

hands without delay to the correct position on the sternum and give a

further 30 chest compressions.

• Continue with chest compressions and rescue breaths in a ratio of

30:2.

• Stop to recheck the victim only if he starts breathing normally;

otherwise do not interrupt resuscitation.

If your rescue breaths do not make the chest rise as in normal breathing, then

before your next attempt:

• Check the victim's mouth and remove any visible obstruction.

• Recheck that there is adequate head tilt and chin lift.

• Do not attempt more than two breaths each time before returning to

chest compressions.

If there is more than one rescuer present, another should take over CPR about

every 2 min to prevent fatigue. Ensure the minimum of delay during the

changeover of rescuers.

6 B Chest-compression-only CPR.

• If you are not able, or are unwilling, to give rescue breaths, give chest

compressions only.

• If chest compressions only are given, these should be continuous at a

rate of 100 a minute.

• Stop to recheck the victim only if he starts breathing normally;

otherwise do not interrupt resuscitation.

7 Continue resuscitation until:

• qualified help arrives and takes over,

• the victim starts breathing normally, or

• you become exhausted.

Explanatory notes

Risk to the rescuer

The safety of both the rescuer and victim are paramount during a resuscitation

attempt. There have been few incidents of rescuers suffering adverse effects

from undertaking CPR, with only isolated reports of infections such as

tuberculosis (TB) and severe acute respiratory distress syndrome (SARS).

Transmission of HIV during CPR has never been reported. There have been no

human studies to address the effectiveness of barrier devices during CPR;

however, laboratory studies have shown that certain filters, or barrier devices with

one-way valves, prevent oral bacteria transmission from the victim to the rescuer

during mouth-to-mouth ventilation. Rescuers should take appropriate safety

precautions where feasible, especially if the victim is known to have a serious

infection, such as TB.

Initial rescue breaths

During the first few minutes after non-asphyxial cardiac arrest the blood oxygen

content remains high. Ventilation is, therefore, less important than chest

compression at this time.

It is well recognised that skill acquisition and retention are aided by simplification

of the BLS sequence of actions. It is also recognised that rescuers are frequently

unwilling to carry out mouth-to-mouth ventilation for a variety of reasons,

including fear of infection and distaste for the procedure. For these reasons, and

to emphasise the priority of chest compressions, it is recommended that, in most

adults, CPR should start with chest compressions rather than initial ventilations.

Jaw thrust

The jaw thrust technique is not recommended for lay rescuers because it is

difficult to learn and perform. Therefore, the lay rescuer should open the airway

using a head-tilt-chin-lift manoeuvre.

Agonal gasps

Agonal gasps are present in up to 40% of cardiac arrest victims. Laypeople

should, therefore, be taught to begin CPR if the victim is unconscious

(unresponsive) and not breathing normally. It should be emphasised during

training that agonal gasps occur commonly in the first few minutes after sudden

cardiac arrest. They are an indication for starting CPR immediately and should

not be confused with normal breathing.

Mouth-to-nose ventilation

Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation.

It may be considered if the victim’s mouth is seriously injured or cannot be

opened, the rescuer is assisting a victim in the water, or a mouth-to-mouth seal is

difficult to achieve.

Mouth-to-tracheostomy ventilation

Mouth-to-tracheostomy ventilation may be used for a victim with a tracheostomy

tube or tracheal stoma who requires rescue breathing.

Bag-mask ventilation

Considerable practice and skill are required to use a bag and mask for

ventilation. The lone rescuer has to be able to open the airway with a jaw thrust

whilst simultaneously holding the mask to the victim’s face. It is a technique that

is appropriate only for lay rescuers who work in highly specialised areas, such as

where there is a risk of cyanide poisoning or exposure to other toxic agents.

There are other specific circumstances in which non-healthcare providers receive

extended training in first aid which could include training, and retraining, in the

use of bag-mask ventilation. The same strict training that applies to healthcare

professionals should be followed and the two-person technique is preferable.

Chest compression

In most circumstances it will be possible to identify the correct hand position for

chest compression without removing the victim’s clothes. If in any doubt, remove

outer clothing.

It has been shown that the same hand position can be

found more quickly if rescuers are taught to ‘place the heel of your hand in the

centre of the chest with the other hand on top’, provided the teaching includes a

demonstration of placing the hands in the middle of the lower half of the

sternum.

Whilst performing chest compression:

a) Each time compressions are resumed, the rescuer should place his

hands without delay ‘in the centre of the chest’.

b) Compress the chest at a rate of about 100 a minute.

c) Pay attention to achieving the full compression depth of 4-5 cm (for

an adult).

d) Allow the chest to recoil completely after each compression.

e) Take approximately the same amount of time for compression and

relaxation.

f) Minimise interruptions in chest compression.

g) Do not rely on a palpable carotid or femoral pulse as a gauge of

effective arterial flow.

h) ‘Compression rate’ refers to the speed at which compressions are

given, not the total number delivered in each minute. The number

delivered is determined not only by the rate, but also by the number

of interruptions to open the airway, deliver rescue breaths, and allow

AED analysis.

Compression-only CPR

Studies have shown that chest-compression-only CPR may be as effective as

combined ventilation and compression in the first few minutes after non-asphyxial

arrest. Laypeople should, therefore, be encouraged to do compression-only CPR

if they are unable or unwilling to provide rescue breaths, although combined

chest compression and ventilation is the better method of CPR.

Over-the-head CPR

Over-the-head CPR for a single rescuer and straddle CPR for two rescuers may

be considered for resuscitation in confined spaces.

Recovery position

There are several variations of the recovery position, each with its own

advantages. No single position is perfect for all victims. The position should be

stable, near a true lateral position with the head dependent, and with no pressure

on the chest to impair breathing.

The Resuscitation Council (UK) recommends this sequence of actions to place a

victim in the recovery position:

• Remove the victim’s spectacles.

• Kneel beside the victim and make sure that both his legs are straight.

• Place the arm nearest to you out at right angles to his body, elbow bent with

the hand palm uppermost.

• Bring the far arm across the chest, and hold the back of the hand against the

victim’s cheek nearest to you.

• With your other hand, grasp the far leg just above the knee and pull it up,

keeping the foot on the ground.

• Keeping his hand pressed against his cheek, pull on the far leg to roll the

victim towards you onto his side.

• Adjust the upper leg so that both the hip and knee are bent at right angles.

• Tilt the head back to make sure the airway remains open.

• Adjust the hand under the cheek, if necessary, to keep the head tilted.

• Check breathing regularly.

If the victim has to be kept in the recovery position for more than 30 min turn him

to the opposite side to relieve the pressure on the lower arm.

http://www.resus.org.uk/pages/bls.pdf

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